August 2nd 2019
PLAC: Planning Your Visit
To schedule an office appointment at either our Fairfax Office or Leesburg Office, please call (703) 289-1410 during regular business hours.
A parent or guardian must be present at the visit.
You will need to bring to the first appointment:
- All current medications,
- Photographs of rash or symptoms if applicable,
- Results of prior testing (skin testing, blood testing, endoscopy, etc) if relevant to your visit with us.
Please bring these items to each appointment:
- The patient’s current health insurance card(s),
- Drug Prescription Card (if applicable),
- Proof of identification,
- Copay, if applicable.
New patients are registered in our system and important patient forms are completed prior to their first appointment.
You may bring these forms with you to your initial appointment:
- Registration Form English | Spanish
- Notice of Privacy Practices English | Spanish
- Consent to Treatment/Acknowledgement of Receipt of Notice of Privacy Practices for parent/guardian of a minor child English | Spanish
- Consent to Treatment/Acknowledgement of Receipt of Privacy Practices for adult patients English | Spanish
- Financial Responsibility Statement English | Spanish
- Medical Permission Form English | Spanish
- New Allergy Patient Intake Form English| Spanish
- New Allergy Patient Instructions English
If you are being seen for Immunotherapy (Allergy Shots), you may also complete the following forms: